title: Ethnic differences in quality of life in insured older adults with diabetes mellitus in an integrated delivery system.
abstract: OBJECTIVE
  To explore racial and ethnic (ethnic hereafter) differences in health-related quality of life (HRQL) in older adults with diabetes mellitus in an integrated delivery system.
  
  
  METHODS
  Observational cross-sectional study.
  
  
  METHODS
  Kaiser Permanente Northern California.
  
  
  METHODS
  Ethnic-stratified, random sample of 6,096 adults with diabetes mellitus aged 60 to 75 who completed a HRQL questionnaire.
  
  
  METHODS
  Physical and mental HRQL were measured based on the Medical Outcomes Study 8-item Short Form Survey (range 0-100, mean 50). Age- and sex-adjusted weighted linear regression models estimated associations between ethnicity and HRQL and evaluated potential mediators (socioeconomic status, acculturation, health behaviors, diabetes mellitus-related conditions). Differences in ethnic-specific, adjusted mean HRQL scores were tested (reference whites).
  
  
  RESULTS
  Physical HRQL was better for Filipinos (48.3, 95% confidence interval (CI) = 47.0-49.6, P < .001), Asians (48.1, 95% CI = 46.8-49.3, P < .001), Hispanics (45.1, 95% CI = 44.2-46.0, P < .001), and blacks (44.2, 95% CI = 43.3-45.1, P = .04) than whites (42.9, 95% CI = 42.6-43.2). Adjusting for potential mediators did not change these relationships. Mental HRQL was better only for Asians (52.7, 95% CI = 51.6-53.7, P = .01) than for whites (51.0, 95% CI = 50.7-51.3), but this difference was small and became nonsignificant after adjustment for socioeconomic status, acculturation, health behaviors, and diabetes mellitus-related conditions.
  
  
  CONCLUSIONS
  In older adults with diabetes mellitus in a well-established integrated healthcare delivery system, ethnic minorities had better physical HRQL than whites. Equal access to care in an integrated delivery system may hold promise for reducing health disparities in diabetes mellitus-related patient-reported outcomes.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA. nlaiteer@medicine.bsd.uchicago.edu
authors.forename: Neda
authors.initials: N
authors.lastname: Laiteerapong
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Priya M
authors.initials: PM
authors.lastname: John
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Liu
authors.forename: Nancy
authors.initials: N
authors.lastname: Adler
authors.forename: Marshall H
authors.initials: MH
authors.lastname: Chin
authors.forename: Elbert S
authors.initials: ES
authors.lastname: Huang
mesh_terms: D000368:Aged; D002140:California; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D003710:Demography; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012042:Registries; D011795:Surveys and Questionnaires
keywords: diabetes mellitus; ethnicity; geriatrics; health-related quality of life; patient-reported outcomes; race